Getting real about bill length

In my conversation with Lamar Alexander yesterday, he kept coming back to the Senate health-care bill's length as a reason that he couldn't support it. "You can’t be sure what’s in the Senate bill," he said, "because it's 2,100 pages long." That seems a bit strange: 10 health-care staffers could read 210 pages each and tell you what's in the bill pretty exactly. That's what they're paid to do, presumably. But let's focus in on the number for a second.

Legislation is written in a very weird format: Large margins, lots of space, giant font, constant indenting. Matthew Yglesias once scanned in part of Page 58 of the health-care bill to make the point. I've reduced it slightly to make it fit the page. So remember: This is smaller than the actual bill:

That makes the bill's page count a lot longer than its word count would imply. To make this point slightly differently, I ran a word count on the bill itself. It's about 338,000 words. Academic books put around 500 words on a page. Run the numbers and the bill would be 796 pages. That's a long book, but it's not that long a book. And it isn't clear why legislation affecting millions of Americans should necessarily be shorter than something I had to read in college.

But it isn't just the formatting inflating the word count. It's the words themselves. Legislation is written for lawyers, not for people. It's full of references to subparagraphs and explanations of what needs to be deleted in previous statutes ensure continuity between new laws and old laws. You saw this clearly in the Senate Finance Bill. The amended bill (pdf) was written in plain English, included a history of past provisions so people could understand the context for the changes in the bill, and was 262 pages long. The legislation itself (pdf) -- which said the same thing in legal-ese -- was 1,504 pages.

That doesn't mean the legislation wasn't, in some sense, 1,504 pages. But what it was doing took only 262 pages to explain. And that seems like a reasonable length for a bill. As for the 1,504 pages, it may be that they're useless or it may be that they're useful. It's certainly possible that precision would make the bill both easier to understand and harder to hide things in than a studied vagueness, even as the vaguer bill would have fewer pages and thus seem simpler.

Ezra: "It isn't clear why legislation affecting millions of Americans should necessarily be shorter than something I had to read in college.
"

And it isn't clear, to me at least, that what is required is a bill that affects not merely "millions" of Americans, but hundreds of millions. I think this bill is overly ambitious. Eight-five percent of Americans are covered by plans with which they are highly satisfied and a high portion of the remainder are undocumented, unemployed, underemployed or free-riding. I think a more modest bill with targetted subsidies and regs could have addressed the coverage problem for far less money - without affecting other people's coverage.

isnt the health care reform bill that would affect millions of americans, worth the time and trouble for these people to read?????
what else do they have to do with their time, than read the health care reform bill over these many months?
maybe they could read a few pages a day.....
it is unreal.

if they cant find the time or mental acumen to read this bill, then why, oh why, did they run for office and get elected??
one can only feel a sense of despair over this.

Go to robertreich.com and read the latest post about how people in CA are having their rates raised by 39% and the nuances behind Anthem's decision to raise those rates.

You are an idiot if you think that 85% of the people would be happy with their current policies if they actually knew how many ways they either are being screwed right now or will be once they get sick.

What if I were to tell you that Al Qaeda was going to kill 15% of Americans, but not to worry because 85% would survive and "be happy"?

Do you actually think about the words coming from your keyboard before you share them?

But it is longer than a 140-character tweet. I'm kidding, of course, but here's my point. Ezra is educated: he can and has read 796-page books. But as we inure ourselves as a culture increasingly to short blog posts and even shorter tweets, the general population will lose its tolerance for longer, in-depth forms. It's not that anyone in the general population is going to read one of these legislative yawners cover-to-cover, but it allows for a cultural disdain of form over content that is not helpful. Tweets are tweets, books are books, and giant legislative documents are all respectable mediums for expressing content.

What would you have a conservative Republican opposing this bill say? At a certain level, you really have to give up on taking people at their word just because they're elected officials. He knows that the number of pages has nothing to do with his support or lack thereof.

tbass1, it seems strange that no one is protesting in the streets about the awesomeness of their insurance carrier if people are so satisfied with their insurance. The 85% number probably represents people that haven't been through a major illness or injury yet. The 15% are the people who actually had to get medical care.

to me the length issue only means that much of it is up to interpretation but that's the case with any legislation not just healthcare. Just like HIPAA and other healthcare regulation much of it can be interpreted or misunderstood one way or another based upon who is looking at it. In practice I've seen different insurance companies interpret rule and law differently. Length affects that but not much else.

The simplest response to citations of how long the bill is in pages: "How many parts are in your car? How are you able to drive it with so many complicated parts? Would you rather have a car that only has 20 parts?"

It is discouraging to see how supposed elected representatives of the people pervert their actions and ambitions. We hear and read of the excesses of the health care bill, of other bills in Congress, and the fact is that all bills are lengthy. As one commenter above points out, these louts are paid to read, understand, and to explain to the public what is being done. In this particular case, the so-called leaders from the Republican party are "sitting out" the game and criticizing the players. We're supposed to be fools who eat up every word.

Oh, how hard it's been for poor Republicans to be heard. But when asked what it is they wish to say, they're back on tort reform. They had a majority in Congress, a Republican President, and they didn't pass tort reform then. They don't want to spoil the lucrative health insurance market for the insurance industry that pumps so much money (which comes from whose premiums? I ask) into Congressional races and lobbying. But there are fools aplenty, apparently, who so want to believe that somehow there's free government if only it's given a chance. Some days one wants just to give up!

What I find truly intriguing about this issue is that the Republican Party (ANY Party, for that matter) would adopt it as a talking point and repeat it, ad nauseam, anytime they're within walking distance of a microphone!

Don't they realize it makes them look/sound really, really dumb, as in, too stupid to be an elected official?

First, the point (the bill's too big) makes them look dumb. Then, they repeatedly remind the public that they're dumb ... which makes them even dumber.

tbass1, it seems strange that no one is protesting in the streets about the awesomeness of their insurance carrier if people are so satisfied with their insurance. The 85% number probably represents people that haven't been through a major illness or injury yet. The 15% are the people who actually had to get medical care.

Posted by: srw3 | February 10, 2010 3:47 PM | Report abuse

srw3,

I love how you think you have an idea about this. How's about this question. If insurers DENY everything (like you assume here about the 15%) then why do we pay so much in healthcare expenses?

Either we pay 2.5 trillion on healthcare expenses or insurers deny every claim. You can't continue to have BOTH sides of the argument.

I've dome research on bill length using word counts to find out for bills in Congress, how long is long. The research showed that the health care bill is, in fact, the longest bill to move through Congress in the past decade. But I also found that both parties write long bill. Of the 10 longest bills in the past ten years, five were written by Democrats and five were written by Republicans.

http://www.opencongress.org/articles/view/1375

I just looked it up, and Lamar Alexander voted "yes" on the second longest bill in Congress over the last 10 years. It's only 68 words shorter than the health care bill.

and claims aren't ONLY illnesses or injuries. Ever heard of MATERNITY. Any idea what that costs? I think the population is still growing so unless we're all having babies at home then I'm thinking insurers are paying for that. Did you forget the study that was done by Medicare that shows Medicare denies more claims that private insurers or do you just not want FACTS to get in the way? Here let me refresh your memory.

Particularly with the revolving door between committee staffers and their former colleagues now on K Street, [1] can we really *trust* what is in these bills?

In 1998 the SEC passed the “Plain English” Disclosure Rule.

One remedy is for a bill’s sponsor (or the chairman if it is his mark) to go on YouTube (we have all day) and describe the overall architecture of the bill (perhaps with PowerPoint), and explain each provision line-by-line in plain English (particularly what “problem” is being solved, including parochial backroom deals that may not be in the broad public interest).

This is Penn President Amy Gutmann’s norm of “reason-giving” in a deliberative democracy [2], and its enforcement mechanism “deliberative accountability.”

The CBO estimate projects that the Senate bill would cost about an extra trillion over the coming decade, but that estimate excludes a costly fix of the Medicare fee schedule (rescinding draconian fee cuts required under current law) which everyone assumes will be passed separately. It also counts 10 years worth of revenue increases against only about 6 years of full benefits. Finally, it projects that the average privately purchased insurance policy would be higher than it would be otherwise.

Yours is a strawman argument. I did not suggest that the remaining 15% of Americans should be left to die. I suggested that a more modest reform bill might be fashioned that would address the uninsured at less cost.

The vast majority of Americans are already insured and most of those people are happy with their coverage. Recognizing this, the President repeatedly pledged that anyone who was happy with their current insurance could keep it. However, he now concedes that that is not the case under either the House or Senate bills. Had he and his party kept that pledge and fashioned a more modest bill they might not have found themselves in their current predicament.

I think you're right that some people who are satisfied with their current insurance coverage would be less so if they had a major illness. The same can probably be said of any existing or proposed health plan. It is also probably true, for instance, that some people who support the Democrats' HCR bill would, should it later come to pass, find that they were unhappy with the result.

tbass 1 wrote: "Eight-five percent of Americans are covered by plans with which they are highly satisfied and a high portion of the remainder are undocumented, unemployed, underemployed or free-riding."

The number of Americans covered by private insurance is in decline. Of Americans who have health insurance, about 34% are covered by government programs. Most of the uninsured are working poor. Stay the course and watch more and more people be priced out of private insurance and more and more be uninsured or on government insurance. A more modest plan won't change that dynamic

i believe you're correct that people who have a major illness would have more incidence to have a "problem" with their insurance just due to the increase in usage. That being said while many are "satisfied" with their insurance people that can't get health insurance now due to pre-exisiting conditions or cost are gladly going to push for reform that they believe benefits them even in a miniscule way without any care for the end result of detriment to the system as a whole. The ironic thing is that when and if the Senate plan is enacted with or without a reconciliation fix and costs are still out of control they'll still be complaining but for different reasons. With the subsides though it'll blunt our feelings towards it because eventually we'll all just be taxed for it and then we'll complain MORE about taxes. I liken it to a life raft that is overflowing. We'd be better off building a new better boat (Wyden-Bennett) but all we're doing is throwing more people onto the life raft and soon it'll capsize.

We also agree, then, that people with pre-existing conditions would likely, as a class, benefit and support health reform. But this group, too, is relatively small and, here again, I feel the Dems' grandiose and costly plans are overkill.

Aside from the cost and the integrity of the projections, one of the things that most concerns me with these bills are the cross subsidies. Young people subsidizing old. Healthy people subsidizing unhealthy people. Men subsidizing women. Wealthy people subsiziing the non-wealthy. I would like for these cross subsidies to be quantified and explicit. Although, I'll grant you, such transparency may well complicate passage.

I agree that the percentage of working age people with insurance is slowly declining. Some of this is due to encroachment of public plans (e.g., the expansion of CHIP). But most is due to the fact that has become so costly that low-wage people would, frankly, prefer the cash value to the benefit and their employers are complying. But here, too, the government is complicit in health inflation. Through the tax treatment of health benefits, any-willing provider laws, mental-health parity laws, etc., the government has, in practice if not intention, been forcing health costs up. I don't see the cost problem, which is closely related to the access problem, as primarily the result of market failure.

"But most [decline in the number of insured] is due to the fact that has become so costly that low-wage people would, frankly, prefer the cash value to the benefit and their employers are complying."

I had not been previously aware that there was a clamor among "low wage people" demanding that their employers remove their health benefits, and that employers (ever sensitive to the wishes of their "low wage people") are giving the people what they want.

It's not a matter of clamboring, it's a matter observed preference in the labor market. An employer's goal is to secure workers of a given skill level for the lowest cost in total compensation as he can. He should be indifferent between spending a dollar in wages or a dollar in purchased health benefits. But because wages are taxed and health benefits are not, employees have a financial incentive to, up to a point, prefer to receive their compensation in the form of untaxed health benefits, rather than wages. And this is what you see unions doing at the bargaining table with management, trading foregone wage increses dollar-for-dollar for richer health benefits. This is why union workers have, over time, garnered such rich benefit plans and stand to run afoul of the proposed tax on "Cadillac" health policies.

But, while the scenario I described holds for moderately- and highly- compensated individuals, it breaks down for low-paid workers. As steveh46 noted, you can't buy food or shelter with health insurance. What's more low-income workers don't tend to pay income taxes so the tax benefit holds less appeal to them. So, in practice, low-paid workers prefer to take most or all of their compensation in the form of wages. Recognizing this, employers of low-paid workers tend not to offer health insurance but try to maximize take-home pay. In a competitive labor market, all employers would offer health insurance (and correspondingly lower wages) if they found that, in doing so, they could be more successful in attracing workers

Unfortunately, those employers of low-paid employees that buck the trend and offer health benefits and correspondingly lower wages, find that the attract mostly people who are seeking employment expressly for the health benefits and, as a consequence, tend to have coslty pre-existing conditions. Adverse selection then pushes up the employer's insurance premiums and he may suffer from absenteeism.

I think that employers of "low wage people" act in their own self-interest, and offer the very cheapest package of wages and benefits that the market will allow. And now that unemployment is sky high, the market will permit just about anything, so the trend of fewer employer-subsidized plans is likely to accelerate.

You can fairly argue that employers are dropping the plans because the employers can't afford to keep up with the annual premium hikes ~and~ maintain wages at the same time, but that is a very different argument from saying that the employees are behind the trend.

"I think that employers of "low wage people" act in their own self-interest, and offer the very cheapest package of wages and benefits that the market will allow."

We are in agreement on these points.

"And now that unemployment is sky high, the market will permit just about anything..."

Disagree, we have minimum wage laws and all manner of other employment laws.

I agree with you that the general trend has been for lower private insurance coverage not with your apparent suggestion that the cause is that employers are tight-fisted.

Wages are sticky, so in times of recession it is hard for employers to trim them. But, over the long run, employers are indifferent between paying their employees in wages or health benefits and that it is employee preference that explains the mix which prevails.

"Disagree, we have minimum wage laws and all manner of other employment laws."

Yes, we do have minimum wage laws to create a baseline saftey net for the protection of "low wage people."

My point is that employers who once might have offered a higher than minimum wage, coupled with a decent package of benefits, will no longer need to, because the job market now lopsidedly favors employers. Many overqualified and long-unemployed job seekers will return to work (if at all) for much less compensation and benefits than they were paid in the past.

"I agree with you that the general trend has been for lower private insurance coverage not with your apparent suggestion that the cause is that employers are tight-fisted."

We can simply agree to disagree on this subject. But for whatever it is worth...

I did not say that employers are tight-fisted. I said that they keep labor costs as low as the market allows for the sake of a healthy balance sheet. When health insurance premiums rise by double digit percentages every year, employers will dump the benefit, especially in a period of high employment. Theoretically that allows more headroom for wages, although I doubt the employee often sees a better wage when his or her benefits are reduced.

So I blame the fact the fewer people have employer-paid health insurance upon the fact that the cost of that insurance is going up too fast for employers to keep pace, not because of any choice or preference on the part of workers at the low end of the wage scale.

It is an employer decision based on the bottom line on the balance sheet. Employers drop health policies because they can't afford to keep them, and because they are willing to bet they can maintain a workforce with adequate skills and morale without paid health insurance. The downward trend is the direct result of the rocket-like annual acceleration in the cost of insurance (especially with smaller pools of employees); to attribute the trend to an exercise of worker choice is to look away from the real cause... more employers are simply getting priced out with each year that passes.

Minimum wage laws are a two-edged sword. They prop up compensation for those lucky enough to secure a job but they also reduce the number of available jobs.

"...the job market now lopsidedly favors employers."

We agree that it is a buyer's market for labor but, even so, there are still plenty of employers going under or just scraping by. It's not a particularly good time for employers or employees these days.

"When health insurance premiums rise by double digit percentages every year, employers will dump the benefit, especially in a period of high employment."

They may, but only because they deem that more palatable to current and prospective employees than pay cuts.

"Theoretically that allows more headroom for wages, although I doubt the employee often sees a better wage when his or her benefits are reduced."

All but monopsonist employers for very specialized labor are price takers when it comes to labor. If they cut their total compensation below the market rate they will find themselves with high turnover and vacancies.

"So I blame the fact the fewer people have employer-paid health insurance upon the fact that the cost of that insurance is going up too fast for employers to keep pace.."

I think there is a bit of that but largely the employee preference for cash wages. If boom times return I suspect private coverage will rebound.

"It is an employer decision based on the bottom line on the balance sheet."

Income statement, I think you mean.

"...to attribute the trend to an exercise of worker choice is to look away from the real cause... more employers are simply getting priced out with each year that passes."

Well, if health insurance was much cheaper then if would be offered much more widely. On that much we can agree. But that's only because employees would find it easier to part with the forgone wage they might otherwise recieve from their employer.

Thanks, we shall agreeably continue to disagree on the issue of whether there is any employee preference against employer paid health insurance in the hope of better cash wages , and whether that purported preference is the reason that every year fewer Americans have employer-subsidized health benefits.

"What I find truly intriguing about this issue is that the Republican Party (ANY Party, for that matter) would adopt it as a talking point and repeat it, ad nauseam, anytime they're within walking distance of a microphone!

Don't they realize it makes them look/sound really, really dumb, as in, too stupid to be an elected official?

First, the point (the bill's too big) makes them look dumb. Then, they repeatedly remind the public that they're dumb ... which makes them even dumber."

Amen. That argument that 'we can't do comprehsive reforms because the resulting document has too many pages' is a confession of stupidity, and any elected official who successfully makes that argument to his or her constituents (I am sorry to say) has some really stupid constituents.

"As for the 1,504 pages, it may be that they're useless or it may be that they're useful."

That's the kicker. If you don't know, or haven't bothered to try, what hope is there for us little people?

And what hope for congress members when they receive bits and pieces at a time with no sense of its final revisions until hours before a vote at the same time being bombarded by constituents, colleagues, lobbyists and media to explain, defend and/or criticize the bill?

Especially those Republicans and a number of Democrats that were excluded from the back-room negotiations and crafting of revisions.

Is it not reasonable that focus was drawn to the length of the bill?
Is it not reasonable for people to point to its length to halt those that claim "to know what's best for Americans" without being able to explain it?
Is it not reasonable for those that oppose substantial bureaucratic control, including its ability to interpret the bill, to point to the bills' overly-ambitious efforts, deceitful methods and secrecy, proponents' unwillingness to explain the bill, arbitrary deadlines, rushed parliamentary procedures and unethical pay-offs to shore up support of Democratic Senators?